Julie Brix Bindslev, Klaus Hansen, Nicol Dara Matoor, T. Stavngaard, C. E. Hoei‐Hansen, T. Truelsen
We performed a nationwide study to examine clinical outcome in children with large‐vessel occlusion (LVO) stroke treated with mechanical thrombectomy (MT) or conservatively. Study participants were enrolled by 2 methods: (1) registration of children assessed through a pediatric stroke triage‐setup from January 2021 to June 2023 and (2) identification of children registered with a stroke or stroke‐related diagnosis in the Danish National Registry of Patients between January 2011 and December 2020. Medical records were reviewed to validate possible stroke events. Children aged 29 days to 17 years with arterial ischemic stroke were included. The children were followed up for cause of stroke, site of vessel occlusion, treatment characteristics, and clinical outcome according to the modified Rankin scale. A total of 181 children with arterial ischemic stroke were identified. Angiography descriptions were available in 133 children and demonstrated LVOs in 28 (21.1%) of these. Fourteen children with LVOs underwent MT and 14 were treated conservatively. Thirteen of 14 (92.9%) children treated with MT achieved successful reperfusion. Periprocedural complications were observed in 2 children, including 1 child who developed symptomatic intracerebral hemorrhage <24 hours from MT. Long‐term outcome was poor (modified Rankin scale score 3–6) in 7 out of 14 (50.0%) children with LVOs treated conservatively and 5 out of 14 (35.7%) children treated with MT. When limiting analysis to MT procedures performed within 24 hours from stroke onset, a poor outcome was observed in 3 out of 11 (27.3%) children treated with MT. Outcome did not differ significantly between treatment groups. This nationwide study demonstrates that MT is feasible and apparently safe to use in children. Among children with LVOs, outcome tended to be better for those treated with MT than those treated conservatively, but outcome did not differ significantly between groups, likely due to small sample sizes.
{"title":"Outcome of Pediatric Large Vessel Occlusion Stroke in Denmark","authors":"Julie Brix Bindslev, Klaus Hansen, Nicol Dara Matoor, T. Stavngaard, C. E. Hoei‐Hansen, T. Truelsen","doi":"10.1161/svin.123.001252","DOIUrl":"https://doi.org/10.1161/svin.123.001252","url":null,"abstract":"\u0000 \u0000 We performed a nationwide study to examine clinical outcome in children with large‐vessel occlusion (LVO) stroke treated with mechanical thrombectomy (MT) or conservatively.\u0000 \u0000 \u0000 \u0000 Study participants were enrolled by 2 methods: (1) registration of children assessed through a pediatric stroke triage‐setup from January 2021 to June 2023 and (2) identification of children registered with a stroke or stroke‐related diagnosis in the Danish National Registry of Patients between January 2011 and December 2020. Medical records were reviewed to validate possible stroke events. Children aged 29 days to 17 years with arterial ischemic stroke were included. The children were followed up for cause of stroke, site of vessel occlusion, treatment characteristics, and clinical outcome according to the modified Rankin scale.\u0000 \u0000 \u0000 \u0000 A total of 181 children with arterial ischemic stroke were identified. Angiography descriptions were available in 133 children and demonstrated LVOs in 28 (21.1%) of these. Fourteen children with LVOs underwent MT and 14 were treated conservatively. Thirteen of 14 (92.9%) children treated with MT achieved successful reperfusion. Periprocedural complications were observed in 2 children, including 1 child who developed symptomatic intracerebral hemorrhage <24 hours from MT. Long‐term outcome was poor (modified Rankin scale score 3–6) in 7 out of 14 (50.0%) children with LVOs treated conservatively and 5 out of 14 (35.7%) children treated with MT. When limiting analysis to MT procedures performed within 24 hours from stroke onset, a poor outcome was observed in 3 out of 11 (27.3%) children treated with MT. Outcome did not differ significantly between treatment groups.\u0000 \u0000 \u0000 \u0000 This nationwide study demonstrates that MT is feasible and apparently safe to use in children. Among children with LVOs, outcome tended to be better for those treated with MT than those treated conservatively, but outcome did not differ significantly between groups, likely due to small sample sizes.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"54 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Kaesmacher, K. Treurniet, M. Kappelhof, T. Dobrocky, J. Ospel, A. Mujanović, J. Fiehler, Bernard Yan, M. Goyal, Albert J. Yoo, Bruce Campbell, Osama O. Zaidat, J. Saver, N. Sanossian, Radoslav Raychev, Y. Roos, Urs Fischer, C. Majoie, J. Gralla, David S. Liebeskind
The expanded Thrombolysis in Cerebral Infarction (eTICI) scale is the default method to measure reperfusion success of endovascular treatment for acute ischemic stroke. It is an estimate of the percentage of the vascular territory affected by the initial occlusion, or target downstream territory (TDT), that is reperfused after the intervention. Traditionally, the size of the TDT is determined on the preinterventional catheter angiography images by delineating the antegrade capillary deficit caused by the catheter angiography target occlusion. As such, the current definition of eTICI grading is only suitable to estimate the efficacy of reperfusion strategies occurring after the baseline catheter angiogram. However, reperfusion therapy for acute ischemic stroke due to large vessel occlusion often encompasses intravenous thrombolysis therapy started prior to endovascular treatment but after cross‐sectional vascular imaging (computed tomography or magnetic resonance imaging) used to determine eligibility for endovascular treatment. The inherent shortcomings of the current eTICI scale to quantify preinterventional perfusion changes are discussed. We then argue that depending on the timing of the studied intervention – either between cross‐sectional imaging and endovascular treatment or after first intracranial catheter angiography – the TDT used to determine the eTICI grade should be based on the occlusion as seen on admission cross‐sectional vascular imaging or prethrombectomy catheter angiography, respectively. We propose a new conceptual framework to grade reperfusion based on the TDT derived from the occlusion seen on cross‐sectional vascular imaging: the cross‐sectional eTICI. Last, we discuss how this definition of the TDT more reliably measures preinterventional reperfusion and establishes homogenous definitions of embolization and infarctions in new territories.
{"title":"Cross‐Sectional Imaging Modalities in Correlation to the Thrombolysis in Cerebral Infarction Score: The Next Frontier in Adjunctive Endovascular Stroke Therapy","authors":"J. Kaesmacher, K. Treurniet, M. Kappelhof, T. Dobrocky, J. Ospel, A. Mujanović, J. Fiehler, Bernard Yan, M. Goyal, Albert J. Yoo, Bruce Campbell, Osama O. Zaidat, J. Saver, N. Sanossian, Radoslav Raychev, Y. Roos, Urs Fischer, C. Majoie, J. Gralla, David S. Liebeskind","doi":"10.1161/svin.123.001063","DOIUrl":"https://doi.org/10.1161/svin.123.001063","url":null,"abstract":"The expanded Thrombolysis in Cerebral Infarction (eTICI) scale is the default method to measure reperfusion success of endovascular treatment for acute ischemic stroke. It is an estimate of the percentage of the vascular territory affected by the initial occlusion, or target downstream territory (TDT), that is reperfused after the intervention. Traditionally, the size of the TDT is determined on the preinterventional catheter angiography images by delineating the antegrade capillary deficit caused by the catheter angiography target occlusion. As such, the current definition of eTICI grading is only suitable to estimate the efficacy of reperfusion strategies occurring after the baseline catheter angiogram. However, reperfusion therapy for acute ischemic stroke due to large vessel occlusion often encompasses intravenous thrombolysis therapy started prior to endovascular treatment but after cross‐sectional vascular imaging (computed tomography or magnetic resonance imaging) used to determine eligibility for endovascular treatment. The inherent shortcomings of the current eTICI scale to quantify preinterventional perfusion changes are discussed. We then argue that depending on the timing of the studied intervention – either between cross‐sectional imaging and endovascular treatment or after first intracranial catheter angiography – the TDT used to determine the eTICI grade should be based on the occlusion as seen on admission cross‐sectional vascular imaging or prethrombectomy catheter angiography, respectively. We propose a new conceptual framework to grade reperfusion based on the TDT derived from the occlusion seen on cross‐sectional vascular imaging: the cross‐sectional eTICI. Last, we discuss how this definition of the TDT more reliably measures preinterventional reperfusion and establishes homogenous definitions of embolization and infarctions in new territories.","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"6 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulsatile tinnitus can be significantly functionally debilitating, with venous sinus stenosis being a largely underrecognized etiology. Establishing a direct cause‐effect relationship can be particularly challenging in pulsatile tinnitus cases without idiopathic intracranial hypertension, and with multifocal, bilateral venous sinus stenoses. Herein, we present a patient with pulsatile tinnitus and bilateral transverse‐sigmoid sinus stenoses on diagnostic angiogram. Temporary stenting using a Tigertreiver was utilized to localize the symptomatic segment. Patient reported resolution of pulsatile tinnitus after deploying the temporary stentriever within the left sigmoid sinus. Subsequently, permanent stenting of the left sigmoid sinus was preformed resulting in complete resolution of symptoms. We highlight the diagnostic challenges of patients presenting with pulsatile tinnitus and venous sinus stenoses, without idiopathic intracranial hypertension. While more experience is needed, temporary stenting may provide an improved method for assessing venous stenting efficacy in patients with pulsatile tinnitus.
{"title":"Novel Approach to Venous Stenting: Tigertriever Temporary Stenting for the Evaluation of Pulsatile Tinnitus","authors":"M. Al‐Kawaz, Kayla Epstein, J. Mocco","doi":"10.1161/svin.123.001009","DOIUrl":"https://doi.org/10.1161/svin.123.001009","url":null,"abstract":"\u0000 \u0000 Pulsatile tinnitus can be significantly functionally debilitating, with venous sinus stenosis being a largely underrecognized etiology. Establishing a direct cause‐effect relationship can be particularly challenging in pulsatile tinnitus cases without idiopathic intracranial hypertension, and with multifocal, bilateral venous sinus stenoses.\u0000 \u0000 \u0000 \u0000 Herein, we present a patient with pulsatile tinnitus and bilateral transverse‐sigmoid sinus stenoses on diagnostic angiogram. Temporary stenting using a Tigertreiver was utilized to localize the symptomatic segment. Patient reported resolution of pulsatile tinnitus after deploying the temporary stentriever within the left sigmoid sinus. Subsequently, permanent stenting of the left sigmoid sinus was preformed resulting in complete resolution of symptoms.\u0000 \u0000 \u0000 \u0000 We highlight the diagnostic challenges of patients presenting with pulsatile tinnitus and venous sinus stenoses, without idiopathic intracranial hypertension. While more experience is needed, temporary stenting may provide an improved method for assessing venous stenting efficacy in patients with pulsatile tinnitus.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"25 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140659852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rodriguez-Calienes, F. Siddiqui, J. Vivanco-Suarez, Sophie Shogren, M. Galecio-Castillo, Mahmoud Dibas, Aditya Pandey, Marc Ribó, S. Ortega‐Gutierrez
This manuscript provides a comprehensive review of intracranial atherosclerosis (ICAS)‐related large‐vessel occlusion (ICAS‐LVO) and its mimics, focusing on the challenges in diagnosis and the need for precise diagnostic methodologies, particularly in the context of endovascular therapy. ICAS‐LVO is a significant contributor to acute ischemic stroke, with varying prevalence rates across regions. ICAS‐LVO is characterized by the presence of residual focal fixed stenosis or reocclusion following endovascular treatment or evidence of distal hypoperfusion or watershed infarction on follow‐up imaging. Despite digital subtraction angiography being the gold standard, diagnosing ICAS‐LVO is complicated by similarities with other occlusive conditions, leading to misdiagnosis and inappropriate interventions. The review explores angiographic mimics of ICAS‐LVO, such as intracranial vasospasm, intracranial dissection, partially occlusive thrombus, and rare vasculopathies like Moyamoya disease, reversible cerebral vasoconstriction syndrome, and vasculitis. Each mimic is meticulously examined, providing insights into their distinctive features, diagnostic considerations, and potential interventions. The manuscript emphasizes the importance of early identification of these mimics to guide appropriate interventions and prevent complications. Future perspectives include the incorporation of advanced imaging tools such as integration of artificial intelligence for automated image analysis, and deployment of advanced imaging techniques such as intravascular ultrasound and optical coherence tomography for a more comprehensive radiographical characterization of ICAS‐LVO. Improved diagnostic criteria and ongoing research will play a pivotal role in addressing the challenges of distinguishing ICAS‐LVO from its mimics.
{"title":"Unmasking the Imitators: Challenges in Identifying Intracranial Atherosclerosis‐Related Large Vessel Occlusion Mimics During Mechanical Thrombectomy","authors":"A. Rodriguez-Calienes, F. Siddiqui, J. Vivanco-Suarez, Sophie Shogren, M. Galecio-Castillo, Mahmoud Dibas, Aditya Pandey, Marc Ribó, S. Ortega‐Gutierrez","doi":"10.1161/svin.123.001303","DOIUrl":"https://doi.org/10.1161/svin.123.001303","url":null,"abstract":"This manuscript provides a comprehensive review of intracranial atherosclerosis (ICAS)‐related large‐vessel occlusion (ICAS‐LVO) and its mimics, focusing on the challenges in diagnosis and the need for precise diagnostic methodologies, particularly in the context of endovascular therapy. ICAS‐LVO is a significant contributor to acute ischemic stroke, with varying prevalence rates across regions. ICAS‐LVO is characterized by the presence of residual focal fixed stenosis or reocclusion following endovascular treatment or evidence of distal hypoperfusion or watershed infarction on follow‐up imaging. Despite digital subtraction angiography being the gold standard, diagnosing ICAS‐LVO is complicated by similarities with other occlusive conditions, leading to misdiagnosis and inappropriate interventions. The review explores angiographic mimics of ICAS‐LVO, such as intracranial vasospasm, intracranial dissection, partially occlusive thrombus, and rare vasculopathies like Moyamoya disease, reversible cerebral vasoconstriction syndrome, and vasculitis. Each mimic is meticulously examined, providing insights into their distinctive features, diagnostic considerations, and potential interventions. The manuscript emphasizes the importance of early identification of these mimics to guide appropriate interventions and prevent complications. Future perspectives include the incorporation of advanced imaging tools such as integration of artificial intelligence for automated image analysis, and deployment of advanced imaging techniques such as intravascular ultrasound and optical coherence tomography for a more comprehensive radiographical characterization of ICAS‐LVO. Improved diagnostic criteria and ongoing research will play a pivotal role in addressing the challenges of distinguishing ICAS‐LVO from its mimics.","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"7 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduced to the clinical field in 2011, the Woven EndoBridge (Sequent Medical) device is recognized as a significant innovation for managing wide‐neck bifurcation aneurysms. Delayed aneurysm ruptures, typically occurring hours to months after Woven EndoBridge placement, have been reported. We present a case of a previously unruptured, known residual aneurysm that ruptured 6 years after treatment with a Woven EndoBridge device. This case underscores the fact that intrasaccular flow diversion, without achieving aneurysm occlusion, does not prevent aneurysm rupture. Consequently, aneurysm retreatment to attain complete occlusion is imperative.
{"title":"Rupture of a Previously Unruptured Cerebral Aneurysm 6 Years After Treatment With the Woven EndoBridge (WEB) Device: Case Report","authors":"A. Drofa, E. Kouznetsov","doi":"10.1161/svin.124.001335","DOIUrl":"https://doi.org/10.1161/svin.124.001335","url":null,"abstract":"\u0000 \u0000 Introduced to the clinical field in 2011, the Woven EndoBridge (Sequent Medical) device is recognized as a significant innovation for managing wide‐neck bifurcation aneurysms. Delayed aneurysm ruptures, typically occurring hours to months after Woven EndoBridge placement, have been reported.\u0000 \u0000 \u0000 \u0000 We present a case of a previously unruptured, known residual aneurysm that ruptured 6 years after treatment with a Woven EndoBridge device. This case underscores the fact that intrasaccular flow diversion, without achieving aneurysm occlusion, does not prevent aneurysm rupture.\u0000 \u0000 \u0000 \u0000 Consequently, aneurysm retreatment to attain complete occlusion is imperative.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"34 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140661109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyun Woo Kim, Ivo Bach, Juan Carlos Martinez Gutierrez, A. Dmytriw, Salvatore D'Amato, Hussein A. Zeineddine, A. Yoo, Sunil A. Sheth
Because of the variability in patient responses to clopidogrel and to reduce the risk of thromboembolic complications, adjusting the antiplatelet regimen based on platelet function testing has become a widespread practice in neurointervention. We aimed to explore current patterns related to this practice. We conducted a survey targeting neurointerventionalists, comprising multiple‐choice questions and opportunities for free‐text responses when necessary. The survey was distributed via a professional society distribution list (the Society of Vascular and Interventional Neurology ) and 2 consortium emailing lists (WovenEndoBridge and Neurointerventional Research Consortia). The data obtained from the responses were analyzed using descriptive statistics. A total of 133 neurointerventionalists, representing 79 institutions within 27 countries, responded to the survey. A total of 62% of respondents tested for clopidogrel resistance before any neurovascular stent placements. A total of 80% used VerifyNow point‐of‐care P2Y12 assay; other assays included multiplate analyzer, platelet function analyzer, and CYP2C19 genotype assay. Respondents reported 25 different therapeutic thresholds, with the P2Y12 reaction unit range between 60 and 180 most commonly used (16.4%). A total of 61% reported they would switch to ticagrelor in the case of persistent resistance. On the other hand, when patients are supratherapeutic, 48% did not make any changes, whereas 42% reduced clopidogrel dose. Finally, 93% opined that a well‐established protocol for management of clopidogrel resistance was needed. Neurointerventional practice patterns around clopidogrel resistance remain heterogeneous. Our results underscore the need for evidence‐based guidance on the management of clopidogrel resistance in neurointervention.
{"title":"Managing Clopidogrel Resistance in Neurointervention: Surveying Current Approaches","authors":"Hyun Woo Kim, Ivo Bach, Juan Carlos Martinez Gutierrez, A. Dmytriw, Salvatore D'Amato, Hussein A. Zeineddine, A. Yoo, Sunil A. Sheth","doi":"10.1161/svin.124.001324","DOIUrl":"https://doi.org/10.1161/svin.124.001324","url":null,"abstract":"\u0000 \u0000 Because of the variability in patient responses to clopidogrel and to reduce the risk of thromboembolic complications, adjusting the antiplatelet regimen based on platelet function testing has become a widespread practice in neurointervention. We aimed to explore current patterns related to this practice.\u0000 \u0000 \u0000 \u0000 \u0000 We conducted a survey targeting neurointerventionalists, comprising multiple‐choice questions and opportunities for free‐text responses when necessary. The survey was distributed via a professional society distribution list (the\u0000 Society of Vascular and Interventional Neurology\u0000 ) and 2 consortium emailing lists (WovenEndoBridge and Neurointerventional Research Consortia). The data obtained from the responses were analyzed using descriptive statistics.\u0000 \u0000 \u0000 \u0000 \u0000 A total of 133 neurointerventionalists, representing 79 institutions within 27 countries, responded to the survey. A total of 62% of respondents tested for clopidogrel resistance before any neurovascular stent placements. A total of 80% used VerifyNow point‐of‐care P2Y12 assay; other assays included multiplate analyzer, platelet function analyzer, and CYP2C19 genotype assay. Respondents reported 25 different therapeutic thresholds, with the P2Y12 reaction unit range between 60 and 180 most commonly used (16.4%). A total of 61% reported they would switch to ticagrelor in the case of persistent resistance. On the other hand, when patients are supratherapeutic, 48% did not make any changes, whereas 42% reduced clopidogrel dose. Finally, 93% opined that a well‐established protocol for management of clopidogrel resistance was needed.\u0000 \u0000 \u0000 \u0000 Neurointerventional practice patterns around clopidogrel resistance remain heterogeneous. Our results underscore the need for evidence‐based guidance on the management of clopidogrel resistance in neurointervention.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"28 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Bilal Tariq, Naoki Kaneko, Grace Prochilo, J. Hinman, David S. Liebeskind
Intracranial atherosclerosis is a leading cause of stroke with a high recurrence rate despite treatment. Numerous factors are proposed to influence stroke recurrence due to intracranial atherosclerosis including lesion eccentricity, plaque characteristics, and computational fluid dynamic metrics, such as wall shear stress. An overlooked variable that intrinsically relates to intracranial atherosclerosis is the location of the arterial segment where the lesion occurs. Variations in cerebral blood flow, arterial anatomy, and flow dynamics are likely drivers of initial lesion development and thus likely to influence stroke recurrence. To date, treatment trials of intracranial atherosclerosis have not considered arterial segment lesion location as an independent variable, failing to account for variations in flow dynamics between each artery. There are limited available data on differences between arterial segments, confined to only post hoc analyses. In this review, we summarize available data on such differences between arterial segments. With the limited arterial segment data available, multiple differences in recurrence of stroke in territory of lesion were identified across trials.
{"title":"Arterial Lesion Location and Outcomes of Intracranial Atherosclerotic Disease","authors":"Muhammad Bilal Tariq, Naoki Kaneko, Grace Prochilo, J. Hinman, David S. Liebeskind","doi":"10.1161/svin.124.001344","DOIUrl":"https://doi.org/10.1161/svin.124.001344","url":null,"abstract":"Intracranial atherosclerosis is a leading cause of stroke with a high recurrence rate despite treatment. Numerous factors are proposed to influence stroke recurrence due to intracranial atherosclerosis including lesion eccentricity, plaque characteristics, and computational fluid dynamic metrics, such as wall shear stress. An overlooked variable that intrinsically relates to intracranial atherosclerosis is the location of the arterial segment where the lesion occurs. Variations in cerebral blood flow, arterial anatomy, and flow dynamics are likely drivers of initial lesion development and thus likely to influence stroke recurrence. To date, treatment trials of intracranial atherosclerosis have not considered arterial segment lesion location as an independent variable, failing to account for variations in flow dynamics between each artery. There are limited available data on differences between arterial segments, confined to only post hoc analyses. In this review, we summarize available data on such differences between arterial segments. With the limited arterial segment data available, multiple differences in recurrence of stroke in territory of lesion were identified across trials.","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"53 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Italo Linfante, W. Clark, D. Houssen, Ricardo A. Hanel, Rwoof A Reshi, G. Dabus, Ronald Jubin, Mona P. Roshan, Star Belnap, Thanh N. Nguyen, J. Grotta, R. Wicks, M. Cipolla, David S. Liebeskind, Raul G. Nogueira
PP‐007 is a polyethylene glycol (PEG)ylated bovine carboxyhemoglobin gas transfer molecule with pleotropic cytoprotective effects, vasodilatation, plasma expansion, and optimization of oxygen delivery. Rodent middle cerebral artery occlusion models have demonstrated that PP‐007 increases blood flow in the collateral circulation and reduces final infarct volumes, supporting a potential role as neuroprotective agent in acute ischemic stroke. We aim to evaluate the safety and feasibility of PP‐007 as an adjunctive treatment to mechanical thrombectomy (MT) in patients with stroke secondary to large vessel occlusion. HEMERA‐1 (CarboxyHEMoglobin OxygEn delivery for Revascularization in Acute Stroke) was a multicenter, prospective, randomized, controlled phase 1 clinical trial. Anterior circulation large vessel occlusion patients were assigned in a 3:1 ratio to receive either PP‐007 (320 mg/kg: 30 min bolus followed by 2‐h infusion) plus MT or MT alone within 24 hours after symptom onset. Comprehensive safety evaluation was performed by independent Data Monitoring Safety Board and Imaging Core Lab. From October 1, 2021 to June 30, 2022, a total of 17 patients were recruited. Age, baseline National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT Score were 74.8±12.7 years, 17.3±4.2, and 7.9±1.8, respectively. Twelve patients were randomized to PP‐007 plus MT, 1 was randomized but not treated, 4 patients were randomized to MT alone. Recanalization of the occluded vessel was achieved in all patients. A transient systolic blood pressure increase (20–40 mm Hg) during the bolus was observed in all PP‐007 patients without any clinical consequences. There were no other safety concerns. No significant safety concerns were identified for the adjunctive use of PP‐007 in patients undergoing MT. (The study was funded by Prolong Pharmaceuticals. URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04677777.
{"title":"HEMERA‐1 CarboxyHEMoglobin OxygEn Delivery for Evascularization in Acute Stroke: A Prospective, Randomized Phase 1 Clinical Trial","authors":"Italo Linfante, W. Clark, D. Houssen, Ricardo A. Hanel, Rwoof A Reshi, G. Dabus, Ronald Jubin, Mona P. Roshan, Star Belnap, Thanh N. Nguyen, J. Grotta, R. Wicks, M. Cipolla, David S. Liebeskind, Raul G. Nogueira","doi":"10.1161/svin.123.001246","DOIUrl":"https://doi.org/10.1161/svin.123.001246","url":null,"abstract":"\u0000 \u0000 PP‐007 is a polyethylene glycol (PEG)ylated bovine carboxyhemoglobin gas transfer molecule with pleotropic cytoprotective effects, vasodilatation, plasma expansion, and optimization of oxygen delivery. Rodent middle cerebral artery occlusion models have demonstrated that PP‐007 increases blood flow in the collateral circulation and reduces final infarct volumes, supporting a potential role as neuroprotective agent in acute ischemic stroke. We aim to evaluate the safety and feasibility of PP‐007 as an adjunctive treatment to mechanical thrombectomy (MT) in patients with stroke secondary to large vessel occlusion.\u0000 \u0000 \u0000 \u0000 HEMERA‐1 (CarboxyHEMoglobin OxygEn delivery for Revascularization in Acute Stroke) was a multicenter, prospective, randomized, controlled phase 1 clinical trial. Anterior circulation large vessel occlusion patients were assigned in a 3:1 ratio to receive either PP‐007 (320 mg/kg: 30 min bolus followed by 2‐h infusion) plus MT or MT alone within 24 hours after symptom onset. Comprehensive safety evaluation was performed by independent Data Monitoring Safety Board and Imaging Core Lab.\u0000 \u0000 \u0000 \u0000 From October 1, 2021 to June 30, 2022, a total of 17 patients were recruited. Age, baseline National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT Score were 74.8±12.7 years, 17.3±4.2, and 7.9±1.8, respectively. Twelve patients were randomized to PP‐007 plus MT, 1 was randomized but not treated, 4 patients were randomized to MT alone. Recanalization of the occluded vessel was achieved in all patients. A transient systolic blood pressure increase (20–40 mm Hg) during the bolus was observed in all PP‐007 patients without any clinical consequences. There were no other safety concerns.\u0000 \u0000 \u0000 \u0000 No significant safety concerns were identified for the adjunctive use of PP‐007 in patients undergoing MT. (The study was funded by Prolong Pharmaceuticals.\u0000 \u0000 \u0000 \u0000 \u0000 URL:\u0000 https://www.clinicaltrials.gov\u0000 ; Unique identifier: NCT04677777.\u0000 \u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":"27 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahmoud Dibas, J. Vivanco-Suarez, A. Rodriguez-Calienes, Gustavo M. Cortez, Vitor Mendes Pereira, H. Nishi, Gabor Toth, Thomas Patterson, David Altschul, C. Feigen, M. Essibayi, M. Galecio-Castillo, Johanna T. Fifi, S. Matsoukas, Peter Kan, M. U. Hafeez, Ajit S. Puri, A. L. Kuhn, Ajay K. Wakhloo, Margarita Rabinovich, Priyank Khandelwal, E. Sauvageau, A. Aghaebrahim, M. Costa, Stephen Monteith, M. Farooqui, Ricardo A. Hanel, S. Ortega Gutierrez
Flow diversion (FD) has emerged as an effective treatment option for intracranial aneurysms. However, there is limited evidence regarding its safety and efficacy specifically for distal and small‐artery aneurysms of the posterior circulation. This study aimed to investigate the outcomes of FD for aneurysms arising from the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and the P2 and P3 segments of the posterior cerebral artery. This is a subanalysis of the Post‐FD (Posterior Circulation Aneurysms Treated With Flow Diversion) registry, highlighting distal aneurysms in the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and the P2 and P3 segments of the posterior cerebral artery treated with FD. Aneurysm characteristics and patient outcomes were described for the total series, and a more focused analysis comparing fusiform/dissecting versus saccular aneurysms was performed. The primary treatment outcome was complete aneurysm occlusion (Raymond–Roy class 1). Primary safety outcome was major ischemic/hemorrhagic stroke following FD. Secondary outcomes included functional outcome, aneurysm retreatment, and in‐stent stenosis. Overall, 36 patients with 36 aneurysms were treated with FD, with a median age of 60.0 years (interquartile range [IQR], 52.8—65.3 years). Of those, 13 were fusiform/dissecting, while 23 were saccular aneurysms. Complete occlusion was achieved in 78.1% for all aneurysms at a median follow‐up of 14.0 months (IQR, 9.3–48.6 months). There was a nonsignificant trend in rates of complete occlusion between fusiform/dissecting (91.7%) and saccular aneurysms (70%; P = 0.151). Major stroke was reported in 2 cases (5.6%) and in‐stent stenosis in 4 (11.1%), and retreatment was required for 4 aneurysms (11.4%) There was no difference in rates of major stroke, in‐stent stenosis, or retreatment between fusiform/dissecting and saccular aneurysms. This study suggests the safety and feasibility of FD for distal aneurysms of the posterior circulation, particularly fusiform/dissecting aneurysms. Further larger‐scale studies are warranted to confirm these findings.
{"title":"Flow Diversion for Small Branches and Distal Aneurysms of the Posterior Circulation: A Subanalysis of the Post‐FD Registry","authors":"Mahmoud Dibas, J. Vivanco-Suarez, A. Rodriguez-Calienes, Gustavo M. Cortez, Vitor Mendes Pereira, H. Nishi, Gabor Toth, Thomas Patterson, David Altschul, C. Feigen, M. Essibayi, M. Galecio-Castillo, Johanna T. Fifi, S. Matsoukas, Peter Kan, M. U. Hafeez, Ajit S. Puri, A. L. Kuhn, Ajay K. Wakhloo, Margarita Rabinovich, Priyank Khandelwal, E. Sauvageau, A. Aghaebrahim, M. Costa, Stephen Monteith, M. Farooqui, Ricardo A. Hanel, S. Ortega Gutierrez","doi":"10.1161/svin.123.001296","DOIUrl":"https://doi.org/10.1161/svin.123.001296","url":null,"abstract":"\u0000 \u0000 Flow diversion (FD) has emerged as an effective treatment option for intracranial aneurysms. However, there is limited evidence regarding its safety and efficacy specifically for distal and small‐artery aneurysms of the posterior circulation. This study aimed to investigate the outcomes of FD for aneurysms arising from the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and the P2 and P3 segments of the posterior cerebral artery.\u0000 \u0000 \u0000 \u0000 This is a subanalysis of the Post‐FD (Posterior Circulation Aneurysms Treated With Flow Diversion) registry, highlighting distal aneurysms in the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and the P2 and P3 segments of the posterior cerebral artery treated with FD. Aneurysm characteristics and patient outcomes were described for the total series, and a more focused analysis comparing fusiform/dissecting versus saccular aneurysms was performed. The primary treatment outcome was complete aneurysm occlusion (Raymond–Roy class 1). Primary safety outcome was major ischemic/hemorrhagic stroke following FD. Secondary outcomes included functional outcome, aneurysm retreatment, and in‐stent stenosis.\u0000 \u0000 \u0000 \u0000 \u0000 Overall, 36 patients with 36 aneurysms were treated with FD, with a median age of 60.0 years (interquartile range [IQR], 52.8—65.3 years). Of those, 13 were fusiform/dissecting, while 23 were saccular aneurysms. Complete occlusion was achieved in 78.1% for all aneurysms at a median follow‐up of 14.0 months (IQR, 9.3–48.6 months). There was a nonsignificant trend in rates of complete occlusion between fusiform/dissecting (91.7%) and saccular aneurysms (70%;\u0000 P\u0000 = 0.151). Major stroke was reported in 2 cases (5.6%) and in‐stent stenosis in 4 (11.1%), and retreatment was required for 4 aneurysms (11.4%) There was no difference in rates of major stroke, in‐stent stenosis, or retreatment between fusiform/dissecting and saccular aneurysms.\u0000 \u0000 \u0000 \u0000 \u0000 This study suggests the safety and feasibility of FD for distal aneurysms of the posterior circulation, particularly fusiform/dissecting aneurysms. Further larger‐scale studies are warranted to confirm these findings.\u0000","PeriodicalId":21977,"journal":{"name":"Stroke: Vascular and Interventional Neurology","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140683260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：